Differing carcinoma diagnoses?

Question fromVA Fiend:
My surgical pathology report indicates, "invasive mammary carcinoma with lobular features (90 percent) and lobular carcinoma in situ (10 percent)." The core biopsy report says "invasive ductal carcinoma." Are these the same thing, or do the two reports differ?

Answers -Ann Ainsworth
Breast carcinomas may originate from the breast ducts that carry the milk or the breast lobules where the milk is made. The cells, which are present in the ducts and lobules, look different under the microscope. Sometimes, however, it is difficult to tell whether the origin of the tumor is ductal or lobular. Sometimes lobular carcinoma and ductal carcinoma can both occur in the same tumor.

In situ lobular carcinoma (also called LCIS and sometimes called lobular neoplasia) means that the tumor cells are present within the lobules where they originated and have not spread to the surrounding breast tissue. This type of cell overgrowth is not truly a cancer, but a marker for future risk of developing breast cancer. Ductal carcinoma in situ (also called DCIS) is a non-invasive cancer which does require treatment.

Beth Baughman DuPree, M.D., F.A.C.S.
Clinically, basic lobular carcinoma may present as a ridge or a density in the breast and may not be as easily found on a mammogram as are invasive ductal carcinomas. And because of the pattern of growth within the breast, (it can form an area of generalized thickening rather than a discrete lump), some invasive lobular carcinomas are more difficult to remove completely with breast-conserving surgery (lumpectomy). Patients found to have LCIS without any other form of invasive cancer are treated with close clinical observation. They'd also be candidates for tamoxifen therapy in order to reduce breast cancer risk.

Marisa Weiss, M.D.
If a woman with a strong family history of breast cancer or a known breast cancer gene abnormality gets LCIS, she may decide to be extra aggressive with her options. Some women in this situation might seriously consider prophylactic mastectomies, to reduce their high risk of getting breast cancer in the future. A woman is at high risk if she has a strong family history of breast cancer (a lot of women affected by breast cancer at a young age, and possibly also having ovarian cancer) or has a proven breast cancer gene abnormality.

The Ask-the-Expert Online Conference called Your Operative and Pathology Reports featured Beth Baughman Dupree, M.D., F.A.C.S. and Ann Ainsworth, M.D. answering your questions about details of pathology and operative reports and the importance of discussing them with your doctors.

Editor's Note: This conference took place in November 2004.

The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.